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Epi-LASIK, IntraLASIK address some corneal surgery limitations

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WAIKOLOA, Hawaii — Both epi-LASIK and IntraLASIK have the potential to transform the refractive surgery market, although preference for one technique over the other will be shaped by which allows faster wound healing, according to one presenter here.

Epi-LASIK is a surface-ablation refractive surgical procedure in which an epithelial flap is created with an epikeratome. IntraLASIK is the term used for LASIK in which the stromal flap is created using the IntraLase FS laser. Ronald R. Krueger, MD, described the two relatively new techniques here at Hawaii 2005, The Royal Hawaiian Eye Meeting.

Both techniques show promise due to their faster visual recovery and more predictable visual outcomes than conventional LASIK, Dr. Krueger said. Clinical results with epi-LASIK, however, are still early and therefore cannot yet be adequately evaluated, he said.

Proponents of epi-LASIK note that creation of an epithelial flap does not involve cutting collagen fibers, resulting in fewer flap problems and less postop biomechanical instability. Studies have shown that epi-LASIK reduces epithelialization time in comparison to other surface procedures, Dr. Krueger said.

Those who favor IntraLASIK say the laser creates a more uniform, predictable stromal flap than a conventional microkeratome, he said. IntraLASIK has been shown in studies to improve the outcomes of customized ablation, with better visual acuity and fewer aberrations, he said.

The techniques are both gaining popularity with some surgeons, according to Dr. Krueger. The IntraLase FS is used in 15% of all LASIK surgery in the United States, the company has said. As for epi-LASIK, at least four companies are now marketing or will soon market epikeratomes (Norwood EyeCare, VisiJet/Gebauer, Moria and AMO), he added.

While both techniques address some of the limitations of conventional LASIK and PRK, procedural differences between the two could translate into differences in wound healing speed and biomechanics, Dr. Krueger said.

“We need to look at histology and anatomy. If we can maintain a good basement membrane, then we can get quicker healing,” he said.